Payer & TPA Solutions
We Help Payers and TPAs Minimize Financial Leakage by Ensuring Documentation Integrity Before Claims Reach Adjudication. Through Proactive Chart Reviews, Denial Analytics, and Targeted Provider Feedback, We Deliver Measurable Reductions in Inappropriate Payments and Recurring Denials — While Improving Compliance and Provider Engagement.
Claims Review (Clinical)
- Medical Necessity Checks → Validate Services Against Evidence-Based Guidelines.
- Utilization & Coding Validation → Ensure Coding Accuracy and Compliance.
- Evidence Summaries for Provider Education → Turn Claim Insights into Learning Opportunities.
Denial Analytics
- Identify High-Frequency Denial Drivers → Uncover Root Causes of Revenue Leakage.
- Closed-Loop Provider Feedback → Deliver Targeted Insights to Reduce Repeat Errors.
- Trend Dashboards & Summaries → Actionable Analytics to Track Progress and Outcomes.
Program Support
- Star Ratings & Quality Measure Alignment → Strengthen Outcomes and Payer Performance.
- Policy & Documentation Checklists → Simplify Compliance for Providers and Internal Teams.
- SLA-Based Delivery & White-Label Reports → Reliable, Transparent, and Brandable Reporting.
This describes services only; PHI is handled in secure, contracted environments.